Healthcare Provider Details

I. General information

NPI: 1942049242
Provider Name (Legal Business Name): USA IMPERIAL HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 S IMPERIAL AVE STE C
EL CENTRO CA
92243-4247
US

IV. Provider business mailing address

2580 HIDDEN VALLEY RD
LA JOLLA CA
92037-4022
US

V. Phone/Fax

Practice location:
  • Phone: 760-592-4783
  • Fax: 760-545-0256
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. UNNATI SAMPAT
Title or Position: PRESIDENT
Credential: MD
Phone: 760-592-4783